Antidepressant use During Pregnancy: Knowledge, Attitudes, and Decision‐Making of Patients and Providers

Abstract

Introduction: Despite the risks associated with untreated perinatal depression and anxiety, both patients and clinicians are less likely to follow evidence-based guidelines including the use of antidepressants during pregnancy. The aim of this integrative review was to describe the perspectives of both patients and prescribing health care providers regarding the use of antidepressants during pregnancy. Methods:We performed a literature search in PubMed, CINAHL, ProQuest Central, and PsychINFO. Inclusion criteria were English language, original peer-reviewed research published within the previous 10 years that described perspectives regarding the use of antidepressants of pregnant patients or prescribing providers during pregnancy. Studies were excluded if their focus was on screening practices, treatment guidelines, or evaluation of decision support tool; medication or treatment broadly; bipolar disorder or serious mental illness; or they did not provide patient or provider perspective. This review was limited to professionals with scopes of practice that include prescriptive authority (eg, physicians, advanced practices nurses, midwives). Included articles were critically appraised and read in an iterative process to extract methodological details and synthesize findings.Results: Nineteen studies met criteria for inclusion and varied by design, sample, and quality. Together, the reviewed articles suggest that patients and prescribing providers hold a range of beliefs regarding the safety of antidepressant during pregnancy. Patients and providers appear to value different sources of information and varied in awareness of the negative impacts of untreated depression and anxiety during pregnancy. Many patients report dissatisfaction with available information and distress throughout the decision-making experience. Notably, patients and providers had incongruent perceptions of the others' experience.Discussion: Inconsistencies between knowledge, attitudes, and decision-making highlight the need for improved dissemination of evidence-based treatments and support increased training for psychopharmacology during pregnancy. Efforts to reduce patient distress regarding their decisions, such as adequate time and information, are indicated.

Psychiatric medication use among pregnant and breastfeeding mothers who used cannabis for mental health concerns: A cross-sectional survey study

“…Ultimately, such variations in practices based on provider beliefs, comfort levels, and a lack of guidance of high-quality recommendations leave many women untreated for depression. 35 All mothers in our sample reported using cannabis to address mental health concerns, yet less than a quarter screened positive for anxiety or depression, and 88% were classified as having mild or no psychological distress in the composite PHQ-4. Although substantial differentially missing data for PHQ-4 limits our ability to draw conclusions about psychological distress between those who did and did not use psychiatric medications, the rate of self-reported symptoms (100% of the sample) is higher than it appeared on the PHQ-4.…”

“…34 This lack of concrete direction may contribute to physician uncertainty about recommending pharmacologic options when offering interventions for mental illnesses perinatally. 35 A 2012 study of postpartum depression found that women were more likely to be prescribed medication treatment (with or without counseling) if their medical practice received specialized training. 36 A 2022 review on the knowledge, attitudes, and decision-making process of patients and providers regarding antidepressant use during pregnancy found that while physicians were confident in these skills, many overestimated the teratogenic risk, and between 20% and 74% avoided starting an antidepressant during pregnancy.…”

Perceived risk of neurodevelopmental outcomes in offspring related to psychotropic and mental illness exposures in pregnancy and breastfeeding: a cross-sectional survey of women with past or current mental illness

“…20 21 In women with a perinatal mental illness, elevated risk perception of adverse outcomes in offspring due to psychotropic medication exposure often affects the decision-making regarding their treatment. [22][23][24] The ongoing debate concerning the reproductive safety of these medications may contribute to confusion and decisional conflicts regarding pharmacological treatment, both among women and healthcare providers. 25 26 Several studies have shown that the perceived teratogenic risk of psychotropic medication use may be unrealistically elevated among pregnant women or recent mothers.…”

Impact of perinatal exposure counseling on patient reported emotional outcomes and decisional empowerment

“…Negative emotions, including guilt and shame have been reported in people who have history of exposures during pregnancy (Cleveland & Bonugli, 2014; Irwin et al, 2005). Studies have shown that feelings of guilt and worry persist regardless of the decision the individual made to stop or continue medication use during pregnancy even when they received reassuring information from their healthcare provider (Eakley & Lyndon, 2022; Mulder et al, 2012). In addition, increasing evidence suggests that anxiety occurs frequently during pregnancy and pregnancy‐related anxiety, characterized by pregnancy specific fears and worries, may be a specific type of anxiety in pregnant populations (Heron et al, 2004; Huizink et al, 2004).…”